Partial anomalous pulmonary venous connection can be safely managed with multiple techniques with low morbidity. The double-patch technique is technically reproducible and offers better results in terms of superior vena cava narrowing and gradient across the pulmonary vein without any increase in complications.
Introduction: The endoscopically harvested vein from thigh usually falls short by half to one length in patients requiring multiple conduits. Increased risk of complications precludes routine endoscopic vein harvest from the leg and an extra incision for open technique is often required thereby nullifying the sole purpose of the former. We employed the endoscope to harvest this extra length of vein from the upper half of the leg with little or no extra risk. Methods: From January 2006 to September 2006 we endoscopically harvested the vein in thigh as well as the leg using the same entry point incision over the medial epicondyle in 40 cases. The only exclusion criterion for the study was a superficial location and subcutaneous visibility of the vein in the leg. We made 3 incisions in each patient of average size 2. 5 cm. Results: Five patients required conversion to the open technique. The average harvest time was 59 minutes. Average length of the conduit was 48 cms. Complications included 1 minor wound infection, 1 case of superficial wound dehiscence, 1 haematoma requiring aspiration and minor erythema at the incision site in 2 patients. Most common complication observed was ecchymosis in 6 patients (5 thigh; 3 leg). None of the patient developed lymphoedema and none required re-hospitalization for vein harvest related wound complications. Conclusion: "Extended endoscopic vein harvest" and avoidance of the open incision was possible in most patients with no additional risk and that the procedure could be routinely employed in patients requiring multiple conduits. (Ind J Thorac Cardiovasc Surg, 2007; 23: 125-127)
Background: Anomalous left coronary artery arising from the pulmonary artery is a rare congenital heart disease. Mortality is in excess of 90% if left untreated during the first year of life. Surgical management has evolved from coronary ligation to anatomical repair by coronary button translocation to the aorta. We report our recent experience with surgical correction of this rare condition.Methods: We retrospectively studied the case records of 14 consecutive patients operated in our institute between Jan 1998 to Aug 2004. The mean age was 65 months _+114 (Range 1 to 420). The male to female ratio was 2.5:1. Coronary ligation was performed in two patients, coronary artery bypass grafting with saphenous vein graft was done in three, the last nine patients underwent coronary button transfer, one patient required concomitant mitral valve replacement. Clinical profile, surgical techniques and operative outcomes as well as long-term results were analyzed.Results: Hospital mortality was 28.5% (4/14), Follow up was 100% complete with no late mortality, ranging from 1 months to five years. Ischaemic mitral regurgitation progressed in only one patient, remained the same in one and improved in all the others. All patients except one are in functional class I at last follow up.Conclusion: In conclusion, infants presenting with a diagnosis of anomalous left coronary artery arising from pulmonary artery with congestive cardiac failure are a difficult subgroup of patients. Coronary button translocation has emerged as the single most effective surgical modality and is associated with good long-term results. (Ind J Thorac Cardiovasc Surg, 2005; 21: 148-152)
Introduction:Left Atrial tumors are known to present in congestive heart failure by their propensity to block flow in the left heart. Myxomas are commoner of these tumors; however other tumors have to be considered. Left atrial myxomas warrant an emergency surgery, however a thorough workup is emphasized even in an emergency.Case Report: A 35 year lady presented to the emergency department with acute congestive heart failure. CXR showed cardiomegaly and florid pulmonary edema. An echocardiogram revealed a 43x33mmleft atrial myxoma (Charuzi class III) and pulmonary hypertension. Since she was too sick, for emergency surgery, medical stabilization was done. A repeat CXR showed clearing of pulmonary edema but also a persistent suspicious opacity in the left upper lung zone. Computed tomography of thorax revealed a mass extending from the arch of aorta into the left atrium and ventricle. Computed tomography guided needle biopsy of the mass showed presence of a primary synovial sarcoma.Conclusions: LA myxomas presenting with congestive heart failure often require emergency surgery. However through evaluation prior to surgery cannot be substituted. Presence of florid pulmonary edema on chest x-ray can mask other lung lesions especially metastasis. In such instances further investigations are necessary to make the correct diagnosis.
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